Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T16:54:59.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Surviving a stressful MIBI scan

Published online by Cambridge University Press:  04 March 2015

Robert Gooch ,
Lisa Bryski  and
Ewa Courvoisier-Grzywacz
Robert Gooch*
Affiliation:
Department of Emergency Medicine, Emergency Medicine Residency Program, The University of Manitoba, Winnipeg, MB
Lisa Bryski
Affiliation:
Department of Emergency Medicine, The University of Manitoba, Winnipeg, MB
Ewa Courvoisier-Grzywacz
Affiliation:
Department of Emergency Medicine, The University of Manitoba, Winnipeg, MB
*
Department of Emergency Medicine, Room T258, Old Basic Sciences Bldg, 770 Bannatyne Avenue, Winnipeg, MB R3E 0W3; [email protected].

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Dipyridamole/technetium sestamibi scans (more commonly known as MIBI scans, an acronym for methoxyisobutyl isonitrile) are used commonly for the diagnosis and risk stratification of coronary artery disease. Adverse events from MIBI scans are extremely rare. We present the case of a 64-year-old man who was successfully resuscitated after two asystolic episodes following dipyridamole infusion for a MIBI scan. The second asystolic episode occurred in the emergency department 40 minutes after the patient had been transferred from the Cardiac Stress Test Laboratory. To our knowledge, there are no previous reports of patients having two discrete asystolic episodes or an asystolic episode as delayed as we report after a MIBI scan. Our case illustrates why emergency physicians should be aware of the potential for asystole following MIBI scanning and why aminophylline, the antidote for dipyridamole, should be readily available in emergency departments that could see patients after pharmacologic stress testing. Patients who become asystolic following dipyridamole infusion likely require prolonged cardiac monitoring, given the potential for further episodes after periods of hemodynamic stability.

Keywords

aminophyllineasystoledipyridamoleMIBI
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 6 , November 2013 , pp. 392 - 396
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1. Henzlova, MJ, Cerqueira, MD, Mahmarian, JJ, et al. Stress protocols and tracers. J Nucl Cardiol 2006;13:e80-90, doi:10.1016/j.nuclcard.2006.08.011.CrossRefGoogle ScholarPubMed
2. Lette, J, Tatum, JL, Fraser, S, et al. Safety of dipyridamole testing in 73,806 patients: the Multicenter Dipyridamole Safety Study. J NuclCardiol 1995;2:3–17, doi:10.1016/S1071-3581(05)80003-0.Google Scholar
3. Frossard, M, Weiss, K, Gössinger, H, et al. Asystole during dipyridamole infusion in patients without coronary artery disease or beta-blocker therapy. Clin Nucl Med 1997;22:97–100, doi:10.1097/00003072-199702000-00005.Google Scholar
4. Akinboboye, OO, Idris, O, Chou, RL, et al. Absolute quantitation of coronary steal induced by intravenous dipyridamole. J Am Coll Cardiol 2001;37:109–16, doi:10.1016/S0735-1097(00)01041-X.CrossRefGoogle ScholarPubMed
5. Camm, AJ, Garratt, CJ. Adenosine and supraventricular tachycardia. N Engl J Med 1991;325:1621–9, doi:10.1056/NEJM199112053252306.Google Scholar
6. Wong, DC, Szeto, E. Reversible severe lower limb pain during a dipyridamole sestamibi myocardial perfusion study: a case report. Clin Nucl Med 1998;23:350–2, doi:10.1097/00003072-199806000-00002.Google Scholar
7. Bjornsson, TD, Mahony, C. Clinical pharmacokinetics of dipyridamole. Thromb Res Suppl 1983;4:93–104, doi:10.1016/0049-3848(83)90364-X.Google Scholar
8. Mahony, C, Wolfram, KM, Cocchetto, DM, et al. Dipyridamole kinetics. Clin Pharmacol Ther 1982;31:330–8, doi:10.1038/clpt.1982.42.Google Scholar
9. Aslaksen, A, Bakke, OM, Vigander, T. Comparative pharmacokinetics of theophylline and aminophylline in man. Br J Clin Pharmacol 1981;11:269–73, doi:10.1111/j.1365-2125.1981.tb00533.x.CrossRefGoogle ScholarPubMed
10. Abu-Laban, RB, McIntyre, CM, Christenson, JM, et al. Aminophylline in bradyasystolic cardiac arrest: a randomised placebo-controlled trial. Lancet 2006;367:1577–84, doi:10.1016/S0140-6736(06)68694-7.Google Scholar
11. Ranhosky, A, Kempthorne-Rawson, J. The safety of intravenous dipyridamole thallium myocardial perfusion imaging. Intravenous Dipyridamole Thallium Imaging Study Group. Circulation 1990;81:1205–9, doi:10.1161/01.CIR.81.4.1205.Google Scholar
12. Picano, E, Marini, C, Pirelli, S, et al. Safety of intravenous high-dose dipyridamole echocardiography. The Echo-Persantine International Cooperative Study Group. Am J Cardiol 1992;70:252–8, doi:10.1016/0002-9149(92)91284-B.Google Scholar
13. Varga, A, Garcia, MAR, Picano, E. Safety of stress echocardiography (from the International Stress Echo Complication Registry). Am J Cardiol 2006;98:541–3, doi:10.1016/j.amjcard.2006.02.064.Google Scholar
14. Sicari, R, Nihoyannopoulos, P, Evangelista, A, et al. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur J Echocardiogr 2008;9:415–37, doi:10.1093/ejechocard/jen175.Google Scholar
15. Blumenthal, MS, McCauley, CS. Cardiac arrest during dipyridamole imaging. Chest 1988;93:1103–4, doi:10.1378/chest.93.5.1103.Google Scholar
16. Lo Mauro, R, Sabella, FP, Enia, F. Sinus arrest associated with dipyridamole infusion. Chest 1994;105:604–5, doi:10.1378/chest.105.2.604.Google Scholar
17. Veeranna, V, Potluri, K, Mahmood, S, et al. Asystole during dipyridamole administration. Indian J Med Sci 2009;63:363–4, doi:10.4103/0019-5359.55889.Google Scholar